title: PD First: peritoneal dialysis as the default transition to dialysis therapy.
abstract: Peritoneal dialysis (PD) and in-center hemodialysis (HD) are accepted as clinically equivalent dialysis modalities, yet in-center HD is the predominant renal replacement therapy (RRT) modality offered to new end-stage renal disease (ESRD) patients in the United States and most other industrialized nations. This predominance has little to do with clinical outcomes, patient choice, cost, or quality of life. It has been driven by ease of HD initiation, physician experience and training, inadequate pre-ESRD patient education, ample in-center HD capacity, and lack of adequate infrastructure for PD-related care. As compared with in-center HD, PD is a widely applicable, yet underutilized modality of RRT that provides comparable clinical outcomes, superior quality of life measures, significant cost savings, and many other unmeasured advantages. A "PD First" approach not only has advantages for patients but also physicians, healthcare systems, and society. In this review, we will summarize evidence demonstrating that PD should be the default modality when new ESRD patients are transitioning to dialysis therapy when preemptive transplantation is not an option and highlight the essential infrastructural requirements to allow for a "PD First" model.
authors.affiliation: Division of Nephrology, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Arshia
authors.initials: A
authors.lastname: Ghaffari
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
authors.forename: Joseph
authors.initials: J
authors.lastname: Lee
authors.forename: Franklin
authors.initials: F
authors.lastname: Maddux
authors.forename: John
authors.initials: J
authors.lastname: Moran
authors.forename: Allen
authors.initials: A
authors.lastname: Nissenson
mesh_terms: D006291:Health Policy; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D010353:Patient Education as Topic; D018579:Patient Selection; D010530:Peritoneal Dialysis / Q000191:economics / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome